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Published on: December 3, 2017
Reduced re-infection rates with postoperative oral antibiotics after two-stage revision hip arthroplasty
Aaron J Johnson1, Michael G Zywiel, Lynne C Jones
1Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, USA. ajjterps@gmail.com
Background:
Surgeons are often trying to decreased reinfection rates following two-stage reimplantation arthroplasty, which range from 3.2% to 13% because multiple staged revision procedures for infection can be costly and have high morbidity. We therefore asked: (1) Did the use of postoperative oral antibiotics reduce reinfection rates after 2-staged revision of THA? And (2) how did this compare with the infection rate after aseptic revision procedures?
Methods:
We identified all patients who underwent two-stage revision THA for a periprosthetic deep hip infection and found 66 patients (67 hips) who had a minimum 24 months' followup. Twenty-two of the 66 procedures (33%) were followed by a minimum of 14 days of postoperative oral antibiotics (mean, 36 days; range, 14 days to lifelong), while 44 were prescribed only immediate parenteral postoperative antibiotic therapy (mean, 1.3 days; range, 1-3 days). We then identified 407 patients (410 hips) who underwent aseptic revision hip arthroplasty and evaluated the infection rate in these patients for comparison; these patients were treated with 24 hours of postoperative parenteral antibiotics. The authors used previously described creteria to establish the presence of infection.
Results:
There were no reinfections in the group receiving oral postoperative antibiotics compared to six reinfections (13.6%) in the 44 patients not receiving oral antibiotics. We observed infection in 2 of the 410 hips (0.5%) revised for aseptic reasons.
Conclusions:
We believe that our findings warrant further investigation for using postoperative oral antibiotics after reimplantation for periprosthetic infection in an effort to decrease the likelihood and risks associated with additional revision arthroplasty procedures.
Insights
Postoperative oral antibiotics significantly reduced reinfection rates after two-stage total hip arthroplasty (THA) reimplantation for infection. This approach may lower risks associated with revision arthroplasty procedures.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Management
- Arthroplasty Research
Background:
- Two-stage reimplantation arthroplasty for hip infection has high reinfection rates (3.2%-13%).
- Multiple revision procedures increase costs and patient morbidity.
- Effective strategies to reduce reinfection after hip arthroplasty are needed.
Purpose of the Study:
- To determine if postoperative oral antibiotics decrease reinfection rates after two-stage revision total hip arthroplasty (THA).
- To compare the infection rate in patients receiving oral antibiotics with those receiving only parenteral antibiotics and with aseptic revision cases.
Main Methods:
- Retrospective review of 66 patients (67 hips) undergoing two-stage revision THA for periprosthetic deep hip infection with minimum 24-month follow-up.
- Group 1: 22 hips received postoperative oral antibiotics (mean 36 days).
- Group 2: 44 hips received only immediate parenteral antibiotics (mean 1.3 days).
- Comparison group: 410 hips undergoing aseptic revision THA treated with 24 hours of parenteral antibiotics.
Main Results:
- No reinfections occurred in the oral antibiotic group (0/22 hips).
- Six reinfections (13.6%) occurred in the group not receiving oral antibiotics (6/44 hips).
- Infection rate for aseptic revisions was 0.5% (2/410 hips).
Conclusions:
- Postoperative oral antibiotics appear to eliminate reinfection after two-stage THA reimplantation for infection.
- Findings suggest oral antibiotics may be a valuable strategy to reduce reinfection risks.
- Further investigation is warranted to confirm the efficacy of oral antibiotics in this setting.